Community Practice

Generics were the big winners in the prescription drug world of 2006. While generic prescription volume was surging 11.4% last year compared with 2005, brand-name Rx volume was falling by 5.1%. Generics now account for 56.9% of all scripts and 63.8% of new scripts.

Last September, the Institute for Safe Medication Practices (ISMP) reported an incident that occurred at a Midwestern hospital. A pharmacy technician had stocked an automated dispensing cabinet with heparin 10,000 units/ml vials in a drawer reserved for heparin 10 units/ml. The nurses retrieving the vials did not notice the discrepancy in strength and used the 10,000 units/ml heparin for umbilical line flushes of six premature infants. Three of the babies died of heparin overdose.

The shift from Republican to Democratic control of Congress ensures ongoing debates about requiring Medicare officials to negotiate directly with pharmaceutical firms for lower drug prices. The Medicare Modernization Act (MMA) expressly forbids interference from the HHS secretary in negotiations between manufacturers and pharmacies or PDP sponsors, and prohibits the establishment of a formulary or price structure for reimbursement under Part D.

Pharmacy industry critics are "gravely concerned" that the Safe Drug Compounding Act of 2007, a draft Senate bill, would sharply curtail the practice of compounding by giving the Food & Drug Administration authority to regulate compounding. A coalition of nine pharmacy organizations drafted a letter to the bill's expected sponsors-Senators Edward Kennedy (D, Mass.), Pat Roberts (R, Kan.), and Richard Burr (R, N.C.)-insisting that the bill "would negatively impact patient access to necessary compounded prescription medications and create onerous, new requirements for prescribers and pharmacists."

The new guide recommends that physicians start with nonpharmacologic treatments such as exercise, physical therapy, weight loss, and heat or cold therapy. If there is no relief of pain, physicians should consider acetaminophen, aspirin, and even short-term use of narcotic analgesics as a first step, taking the patient's medical history into account.

For the 4.4 million American children who have attention deficit hyperactivity disorder (ADHD), there will soon be another option for treatment. The Food & Drug Administration recently approved the first prodrug to treat the condition: lisdexamfetamine dimesylate (Vyvanse).

I would like to speak to your Feb. 5 article on workplace violence. After 16 years as a neighborhood retail pharmacist, I closed my store and went into hospital pharmacy. One of the reasons was that I had started carrying a loaded pistol and had psyched myself that I would shoot someone who tried to rob me. This is no way to live.

Aliskiren (Tekturna, Novartis) is a new molecular entity approved for treating hypertension either as monotherapy or in conjunction with other antihypertensive agents.

When measured by retail dollars, nine out of the top 10 companies were brand-name firms, with Teva Pharmaceuticals being the only generic representative that made the list. When measured by number of prescriptions, three out of the top 10 companies were generic drugmakers, including Teva, Mylan, and Watson Pharma.

Brand-name drugmakers must have seen January as the 100 Hours from Hell. Generic drugmakers, on the other hand, probably heard angelic choirs. "It's safe to say that you can expect different outcomes in Congress under the Democrats," said Anna Schwamlein Howard, senior legislative representative for AARP. "You will see a lot of things being taken up and moving during this Congress that were never addressed under the last Congress."

The Deficit Reduction Act is the federal government's attempt to slow the pace of spending growth in Medicare and Medicaid. Under the act's provisions, the basis for state Medicaid programs' prescription reimbursement to pharmacists changes from average wholesale price (AWP) to average manufacturer price (AMP).

When is $4 not $4? Apparently when it's the cost of a Wal-Mart generic in a state where the retail giant and its competitors may be violating predatory-pricing laws. Those laws ban selling products below cost in order to kill off competitors and may apply to prescription drug sales in 21 states, according to the National Conference of State Legislatures (NCSL) and the National Community Pharmacists Association.

At the Generic Pharmaceutical Association meeting in Phoenix last month, Drug Topics' Managing Editor of Projects, Anthony Vecchione, spoke with Gary Buehler, R. Ph., Director, Office of Generic Drugs.

The terms being used to describe these generics-biogenerics, generic biologics, biological follow-on products, biosimilar drugs, generic biopharmaceuticals-are interchangeable, but the question of how to determine whether these generics are safely interchangeable with the branded products is only now starting to be answered.

John Quincy Adams had been earning his annual $25,000 salary as the sixth U.S. President less than two months when Dr. Adam Carl opened his drugstore in the small south central Pennsylvania town of Greencastle.

Pharmacy education has been in an almost constant state of change for the past 150 years, since the era when a pharmacist learned by being an apprentice. That era was followed by a combination of apprenticeships and courses at local apothecary schools, and then by matriculating in schools of pharmacy for degree programs that gradually have been extended over the years.

When you start looking, "you find pharmacists at every level of every endeavor and every industry that touches on health care," said pharmacy consultant Marsha K. Millonig, MBA, R.Ph., president of Catalyst Enterprises in Minneapolis. "Pharmacists have gone from making drugs to managing the use of drugs. But in a larger sense, pharmacists are doing what we have always done, evolving with society to find a role and fill it."

What started as an innocent hobby has become a full-time and expanding art business for Philip McCarthy. The founder of Apothecary Images, McCarthy began collecting antique and historic pharmacy items nearly 20 years ago. "Pharmacists invited me into their basements to see their antique and historic items," he explained. "I fell in love with anything related to pharmacy."

Any combat veteran will acknowledge that the two most important members of his squad are the radioman and the field medic, the two prized targets for any enemy sniper. Pharmacists have played an indispensable role in all too many wars and are an important part of the field medical team.

Pharmacists could argue for days over what has been the most significant therapeutic advancement in the past 150 years. Some might consider antibiotics to have had the biggest impact in preventing the spread of bacterial infections, while others could argue that vaccines have had a similar effect.

Pumping adrenaline as German planes roared in from behind his squadron in the skies above Anzio, Italy, the rookie pilot jettisoned his P-40 Warhawk's empty external fuel tank to gain speed. Bracing for his first dogfight, he failed to switch on the main fuel tank. A hand-me-down from the Flying Tigers, complete with Chinese writing in the cockpit, the plane's engine cut out.

The next 25 years hold promise of more clinical involvement and collaboration ? and more respect for pharmacists.

When Carl Dew was in the seventh grade, his teacher asked the class to practice filling out a job application. "I wrote the application to Lane Drug Co. in Knoxville," said Dew, owner of Corner Drug Store in Lake City, Tenn.

For 171 years a Thompson has been behind the counter at Thompson Drugs. Six generations of Heimstreets have counseled patients. The fourth generation of Seiferts recently began practice as a pharmacist, while Rupal Patel, a professor of pharmacy, is following the trail her grandfather blazed ... in India.

A frail 75-year-old man, T.W., has been admitted to your hospital. He has a fever of 102°F, along with bloody diarrhea and abdominal pain. Prior to his admission, T.W.'s medications included the following: valsartan (Diovan, Novartis ) 80 mg daily, metoprolol 25 mg daily, aspirin 81 mg daily, simvastatin 40 mg daily, warfarin 3 mg on Monday, Wednesday, Friday and 2 mg on Tuesday, Thursday, Saturday, and Sunday. (T.W. suffered a myocardial infarction six months ago.) His last INR was 4.0. Because he had been hospitalized 14 days prior for S. pneumoniae pneumonia that was treated with ceftriaxone, the admitting physician suspected a C. difficile infection, which was subsequently confirmed by the lab. The physician has now ordered metronidazole 500 mg three times daily for T.W., and your computer flags that as a significant drug interaction. What do you recommend to the physician?

Pharmacist salaries are still climbing, but at a slower rate. Our exclusive survey shows who gets top dollar.

A new specialty certification may be on the horizon. The Board of Pharmaceutical Specialties (BPS) could offer ambulatory care certification as early as 2008. "BPS got the ball rolling, but we have not committed to the development of this specialty," said BPS executive director Richard Bertin. "It is up to the profession to present arguments, pro and con, before that decision can be made."

The National Community Pharmacists Association is warning that implementation of a proposed rule for reimbursement for generic drugs through Medicaid may result in many pharmacies pulling out of the program or going out of business. Citing the results of a recent Government Accountability Office study and its own internal polling of members, Bruce Roberts, NCPA executive VP/CEO, warned that under the new rule patients would face a "serious danger of losing access to lifesaving prescriptions. What we're faced with is not a natural disaster but a public policy disaster."

As part of the 1987 international Montreal Protocol treaty to reduce/eliminate substances depleting the ozone layer, CFC (chlorofluorocarbon) propellants in albuterol metered-dose inhalers (MDIs) are gradually being replaced by HFAs (hydrofluoro-alkanes). The transition need not be complete until Dec. 31, 2008, when albuterol CFC-MDIs must be discontinued as mandated by the Food & Drug Administration. But the change is well under way. As Patty Johnson, spokeswoman for GlaxoSmithKline, noted, "We [GSK] already transitioned to Ventolin HFA MDI in early 2006."

The Agency for Healthcare Research & Quality (AHRQ) recently released guides for clinicians and consumers on the use of analgesics for treating pain associated with osteoarthritis (OA). The guides draw on a report, called "Comparative Effectiveness and Safety of Analgesics for Osteoarthritis," based on a review of 351 published research studies. It represents the most comprehensive analysis to date of analgesics for osteoarthritis pain.